The letter is co-signed by Robert Malooly, assistant director for Insurance Services, and L&I Medical Director Gary Franklin. They write that in 2000 and 2001, the Drug Enforcement Administration identified 464 deaths nationwide associated with the use of the drug OxyContin. Among injured workers in Washington, as many as 40 to 60 deaths have been attributed to prescribed, opiate-based painkillers that were misused or overused between 1995 and 2003.
A recent article on opiate use in the New England Journal of Medicine concluded, "Scientific evidence does not yet provide clear guidance on which patients with chronic, non-cancer pain can safely use opiate-based pain relievers, in what dose, or for how long. Whereas it was previously thought that unlimited dose escalation was at least safe, evidence now suggests that prolonged, high dose opioid therapy may be neither safe nor effective."
Franklin said L&I has identified two patterns that may be related to deaths in Washington - a dramatic shift from Schedule III opiates to the more potent Schedule II opiates, and a substantial increase in average daily dosage. Between 1997 and 2001, the average daily morphine equivalent dosage went from 80 mg to over 130 mg. Franklin said the opiates become particularly dangerous when used in conjunction with other pain medications, anti-depressants and muscle relaxants.
Accompanying the letter was an article from the New York Times on the difficulty of striking a balance between relieving pain and addiction. The mailing also included L&I's Opiate Guideline, which was developed in collaboration with the Washington State Medical Association.
Labor and Industries provides workers' compensation insurance coverage to about 70 percent of the state's workers. Last year, the agency approved and paid for 400,414 prescriptions. Of those, about 150,000 were for opiates.
